Annuity Submission Form

NEW Annuity Submission

VA - FIA - RILA
Did the writing advisor complete all product specific training & obtain all licensing required for this submission? If no, please complete all requirements, then submit.*

Yes (Proceed with submission)No (Please complete all required training / licensing)
Priority:
If urgent is selected, please choose a reasonable due date and be sure of correct delivery method. Communicate directly with the New Business team with any further clarification necessary.
Documents Requested By:

MonthDayYear
Date
Delivery Method:*
New Accounts Team - Client Communication

Prep App ONLY - No client communication at this time
Rep Information:
Primary Representative:*
Servicing/Submitting Representative:*
Will there be a Split Rep or Rep Change?

Yes
Secondary Rep in Split:
Split Rep Details or Rep Change Information:
Please confirm by checking the boxes that the following details are in Redtail. This submission can not proceed without this information*

Beneficiaries with dates of birthClient(s) Social Security numbersCurrent IncomeCurrent Expenses
If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*

YesNo
Has the statement been collected?

YesNo
Where is the statement?
scanned & emailed to team, saved in client docs, saved to RT, handed to team, on the wall?...
Please explain when and how the statement will be provided
Contract Ownership Details:
Owner Name:*

First NameMiddle NameLast Name
Owner Employment Status:*
Owner Age:*
Joint Owner Name:

First NameMiddle NameLast Name
Annuitant Name (If different than owner name):

First NameMiddle NameLast Name
Beneficiary Information - Full names - Relationship - Primary or Contingent - % of distribution. If Trust, full name of Trust and Trust date:*
For Compliance: DO NOT include DOB or Social Security Numbers here, but DO make sure these details are in RT.
Annuity Details:
Annuity Type:*
Funding Source:*
How is this account being funded? Select all that apply:

CashBrokerage AccountAnnuity401k/403b/etc
Do you know the name of their plan?*

YesNo
Plan Name of Employer Sponsored Plan:*
Does the client have access to their Form 404(a) (5)?

YesNo
Fund Fee (%)
Admin Fee (%)
Is the client currently employed at this company?*

YesNo
How much access does the plan provide?*

No AccessComputer AdvicePhone AdviceComputer & PhonePersonal Advice
Which best describes the company's size?*

Smaller (1-49 empls)Midsized (50-199 empls)Larger (200-999 empls)Enterprise (1000+ empls)
Total amount of loans against the plan? ($)*
Percentage of assets in company stock?*
Is the client satisfied with plan investment options?*

YesNo
Does the plan offer other insurance products as a benefit?*

YesNo
Does the plan offer a self-directed option?*

YesNo
Does the plan offer life insurance as a benefit?*

YesNo
Would the client like to consider a cashout?*

YesNo
Registration Type:*
Registration:*
i.e. Trust, Roth IRA, IRA, Simple IRA
New Contract Company Name:*
New Contract Product Name:*
New Contract Rider(s):
Investment Amount:*
Rebalancing Frequency: Default for Annuities is NONE. Will only be added if requested.
Please describe custom rebalancing request
Dollar Cost Average:
VA Allocation:
RILA Allocation:
FIA Allocation:
VA Owner Age Range:

0-8081-8586-90
RILA Owner Age Range:

0-8081-8586-90
FIA Owner Age Range:

0-8081-85
VA Comp Option (Owner Age 0-80):*
VA Comp Option (Owner Age 81-85):*
VA Comp Option (Owner Age 86-90):*
RILA Comp Option (Owner Age 0-80):*
RILA Comp Option (Owner Age 81-85):*
RILA Comp Option (Owner Age 86-90):*
FIA Comp Option (Owner Age 0-80):*
FIA Comp Option (Owner Age 81-85):*
Additional Comp Details
Social Security (monthly) $:*
Pension (monthly) $:*
Spouse - Pension (monthly) $:
Spouse - Social Security (monthly) $:
Individual FA Production Tracking

The following fields are for production tracking of every Rep. Provide accurate details for your benefit.
Money Type*
What is the current trail?*
Will this create increased or decreased revenue for the term of the investment?*
What is the annual percent of increase or decrease?*
Notes & Funding Instructions:*
Please be specific regarding the funding of this account.
Distributions - IMPORTANT - Please ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.

Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track.
Does the account need to be setup for monthly distributions?*
Will this impact an already established routine distribution in the TO or FROM account?*

YesNo
Please provide detail necessary to define the distribution plan
Suitability/Duty of Care:

SUITABILITY QUESTIONS:
Reasons for recommending this annuity:
Main reason for recommendation:
Main reason other:
2nd reason for recommendation:
2nd reason other:
3rd reason for recommendation:
3rd reason other:
Any additional information
What SPECIFIC types of accounts and SPECIFIC products were discussed as an alternative to this product? Submissions require the NAMES of products and not just product types.*
Our staff will be asked to provide specific names of products and not just general types of products. Please assist by providing our team with those details.
What specifically about this product motivated you and the client to choose it?*
How long does the client intend to own the proposed product?
Does the client plan to take income from the proposed annuity?*

YesNo
At what age does the client plan on taking income?*
SUITABILITY SUPPLEMENT:
Is this annuity replacing an existing annuity?

YesNo
Does the annuity being replaced have any kind of rider the client has been paying a fee for?
If yes,
Describe other:
Please provide rationale for why the client is replacing willing to "give up" this benefit for the new product.*
If the new product has an INCOME BENEFIT rider, please indicate primary need.
Reasons for surrender: (select all that apply)

Higher Risk/Reward PotentialHigher Interest Rate GuaranteeAdd an Enhanced Death BenefitAdd an Enhanced Death BenefitAccess to a unique or individual investment strategyStep Up in Death BenefitReduce Market RiskAdd/Replace a Living BenefitNeeds Immediate IncomeOther
Please choose all applicable:

Client's total VA/RILA/FIA holdings exceed 60% of their total investable assets [Complete Section A]Client is age 70 or greater [Complete Sections A and B]Client is age 45 or younger [Complete Section C]
Client's total VA/RILA/FIA holdings exceed 60% of their total investable assets [Complete Section A]*
SECTION A - VA/RILA/FIA HOLDINGS EXCEED 60% OF TOTAL INVESTABLE ASSETS OR CLIENT IS AGE 70 OR GREATER

Indicate client's TOTAL annual expenses:
Current Expenses:*
If expenses reduced or increased during retirement, (i.e., reduced mortgage, or other) please list reduced amount:*
SECTION B - CLIENT AGE 70 OR GREATER: (Reminder: Please also complete Section A)
Did you discuss all applicable maximum age limitations for the guaranteed benefit values involved?*

YesNoOther
If choosing an income benefit rider: Please indicate the primary need or intention for the distributions:
Health/Long Term Care
Charity/Giving
Travel/Leisure
Living Expenses
Other (Describe)*   *
If choosing a lifetime withdrawal rider, is the client aware that the principal has to be fully depleted before the rider provides additional guaranteed value? (Withdrawal benefits will typically require as many as 15-20 years to recognize additional returns due to the maximum withdrawal restrictions of the benefit.)*

YesNoOther
Was there anyone else involved with this purchase decision?*

YesNoOther
If your client is age 80 or greater, please comment on his or her understanding of the attributes and risks of the proposed annuity:*
SECTION C - CLIENT AGE 45 OR YOUNGER
If the client's employment situation changed, would he or she anticipate a need to access cash values from this annuity beyond the product and IRS restrictions?*

YesNo
Does the client have the ability to contribute to an employee sponsored retirement plan?
Yes
No*


If yes, is the client contributing or planning on contributing into the plan?
Yes
No*
Does the client intend to make continuing contributions into this proposed annuity?
Yes
No*
If choosing an income rider: please explain why guaranteeing income is important now. (The likelihood of receiving additional benefit may be decreased with longer holding periods, and potential growth may be impacted by the cost of the rider.)*
Notes - Enter any applicable information related to this case. (Ex. Annuity carrier or product detail consideration)
Should be Empty:

	1a. Current Income	Source
Amount:
Amount:
Amount:
Amount:
Amount:

NEW Annuity Submission

Rep Information:

Contract Ownership Details:

Annuity Details:

Individual FA Production Tracking

Distributions - IMPORTANT - Please ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.

Suitability/Duty of Care:

Reasons for recommending this annuity:

SUITABILITY SUPPLEMENT:

SECTION A - VA/RILA/FIA HOLDINGS EXCEED 60% OF TOTAL INVESTABLE ASSETS OR CLIENT IS AGE 70 OR GREATER

SECTION B - CLIENT AGE 70 OR GREATER: (Reminder: Please also complete Section A)

SECTION C - CLIENT AGE 45 OR YOUNGER